title: Specialist geriatric medical assessment for patients discharged from hospital acute assessment units: randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of specialist geriatric medical management on the outcomes of at risk older people discharged from acute medical assessment units.
  
  
  METHODS
  Individual patient randomised controlled trial comparing intervention with usual care.
  
  
  METHODS
  Two hospitals in Nottingham and Leicester, UK.
  
  
  METHODS
  433 patients aged 70 or over who were discharged within 72 hours of attending an acute medical assessment unit and at risk of decline as indicated by a score of at least 2 on the Identification of Seniors At Risk tool.
  
  
  METHODS
  Assessment made on the acute medical assessment unit and further outpatient management by specialist physicians in geriatric medicine, including advice and support to primary care services.
  
  
  METHODS
  The primary outcome was the number of days spent at home (for those admitted from home) or days spent in the same care home (if admitted from a care home) in the 90 days after randomisation. Secondary outcomes were determined at 90 days and included mortality, institutionalisation, dependency, mental wellbeing, quality of life, and health and social care resource use.
  
  
  RESULTS
  The two groups were well matched for baseline characteristics, and withdrawal rates were similar in both groups (5%). Mean days at home over 90 days' follow-up were 80.2 days in the control group and 79.7 in the intervention group. The 95% confidence interval for the difference in means was -4.6 to 3.6 days (P=0.31). No significant differences were found for any of the secondary outcomes.
  
  
  CONCLUSIONS
  This specialist geriatric medical intervention applied to an at risk population of older people attending and being discharged from acute medical units had no effect on patients' outcomes or subsequent use of secondary care or long term care.
authors.affiliation: University of Nottingham, Division of Rehabilitation and Ageing, Medical School, Queens Medical Centre, Nottingham NG7 2UH, UK.
authors.forename: Judi
authors.initials: J
authors.lastname: Edmans
authors.forename: Lucy
authors.initials: L
authors.lastname: Bradshaw
authors.forename: Matthew
authors.initials: M
authors.lastname: Franklin
authors.forename: John
authors.initials: J
authors.lastname: Gladman
authors.forename: Simon
authors.initials: S
authors.lastname: Conroy
mesh_terms: D000208:Acute Disease / Q000534:rehabilitation*; D000368:Aged; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006699:Home Care Services / Q000458:organization & administration*; D006757:Hospital Units / Q000706:statistics & numerical data*; D006801:Humans; D007326:Institutionalization; D017063:Outcome Assessment, Health Care / Q000379:methods*; D010351:Patient Discharge / Q000639:trends*; D011788:Quality of Life